IamSusan

Here is a link to a terribly sad story that includes an audio file of a baby grunting. Hurt by Homebirth: Wren's story, on the 1st anniversary of his birth and death

Seems like a set up for the hospital to get sued to me. What are you supposed to do stand there while a patient precips or codes and say... but I don't have orders? Your hospital isn't backing you up with protocols and if they are putting you between that kind of a rock and a hard place then I would say find another job. What the others are saying about EMTALA is true. You really can't legally use this as an excuse not to provide needed care legally. But if your manager can't see that there is a big problem. Good luck!

Honestly, if you want to know if being an RN is a handicap as a doula I would post the question on Mothering. But, seriously, Certified Nurse Midwives are the most educated midwives around and that's the safest route to becoming a midwife. If you become a CPM ( certified professional midwife) you will be limited to ONLY homebirths and your education won't be up to par with any other countries first world midwives. When they compare midwives to midwives in Europe the education is university level and far more similar to our CNMs. In fact a CPM isn't a degree at all, and would not be recognized in any other country. In hospitals, a doula with RN experience would likely be seen as a plus, as long as she stuck to her support person role. At home births, among the hard core natural crowd, people with an RN or seen as part of the medical establishment can be viewed with suspicion ( in the most extreme circles ) because they are seen as viewing birth as a disease rather than a natural process. Birth is a natural process with a lot of inherent risk. Not sure if that answers your question?

In real life, in my settings, I would put on a call light or emergency light, and ask for another nurse. Often, this would be the charge nurse, who would then notify anyone who needed to come. Let's say you don't have an IV... you aren't set up at all. One nurse would be doing fundal massage, one might be getting the hemorrhage cart ( that's becoming standard), one would be starting an IV, another might be making phone calls. It would all depend upon your unit, resources, and the severity of the bleeding. Normally, you would not need a pharmacist because all OB units should have the meds they need unit, though I suppose I could imagine needing one if for example the pt was a Jehovah's witness, there are "bloodless" protocols but I would need to look that up. But the lab tech might be getting labs like a CBC with platelets, they would be typing and cross matching blood, the ward clerk could be the one calling in resources, filling out requisitions etc, if you have an OB tech she could do the same, she could be weighing blood loss, getting things needed, someone would be putting on O2.... ideally someone would be talking to the family too. It really all depends on the severity and the staff you have. Some small units might be calling in a house supervisor or rapid response... the idea is that you have a predefined plan on your unit of who does what and takes what role depending on severity. There are lots of things in nursing that run on protocols like this, ACLS, NRP... it's actually a great assignment because your instructor has you thinking about how to communicate in an emergency and reprioritize depending on the changing needs of your patient. ( ps never ever forget psych social in nursing school assignments so make sure you include social worker or nurse to explain to family what is going on and get consents etc)

Someone else mentioned this but I think it bears repeating, the instructor may have indeed taken the error very seriously, but she has an obligation to not discuss the other student's errors with her classmates. I can't think of how many times I have heard only one side of an issue where a nurse was reprimanded. On rare occasion I have known the backstory and in every case the nurse reprimanded was not sharing the whole picture. The facebook post though, sort of scary that she could not identify for herself that it was very inappropriate. It's way easier to teach a skill to a nurse, or anyone, than tact and communication skills.

Postpartum Hemorrhage Algorithm https://www.cmqcc.org/resources/ob_hemorrhage/protocols_guidelines Those links should help in terms of team members it would depend on how severe. It could range from a RN getting orders from an OB ( but, if you want to add team members you could add charge nurse, second RN, ward clerk, tech, pharmacy and lab ) as you progress to more severe you could be calling a rapid response team, add second OB, anesthesiologist, again lab ( and blood bank ), possibly an interventional radiologist, OR crew .. a mother could end up going to the ICU and then you would have a critical care doctor and RN and RT involved. Social worker. It really depends on your hospital policy who is called when but I hope some of that helps you get on the right track!

I would say that if you do become a labor and delivery nurse you will find many others who came to the profession with the same beliefs you do. I know I did, I had even had a home birth. Some nurses do enter the profession and don't change any beliefs at all. Far more from what I see do start to see that there is an element of fundamentalism in the natural birth world that's far less accepting of change or evidence based than mainstream obstetrics. Also, mainstream obstetrics varies so much regionally -- there certainly are areas of the country with very dogmatic and non evidence based practices. But what I found is that in general, doctors and nurses I work with are far more open to change, research based, respectful of patient's rights to self determination and self critical than what I saw in the alternative midwifery world. So, while I still would, and did, choose and unmedicated natural birth, and I love to care for those patients, I really don't think any longer that my way of birth is superior at all to the mom who decides upon an epidural. In that way I sort of cringe at the Business of Being Born, because it presents natural birth in a sort of "we have the secret" almost religious sort of way that I have come to find is far too common. The tears of joy when a new mom with an epidural holds her baby are every bit as powerful as watching a new mom after a natural birth. Of course you didn't even say that's your belief, and it's probably not, but its a tacit message in so much of the natural birth literature, "our way is superior", and I have come to believe it's really not. However, I still am completely supportive of women who want that and good at supporting them. I just see it all with a new perspective and I think I speak for a lot of labor nurses who came to nursing with similar beliefs. Also, these alternative birth things aren't really all that new, I have been a nurse for 25 years and we have been skin to skin, no separation of mom and baby at all, no prep, no must have an IV, have who you want at your birth including siblings ... always supportive of moms who want a natural birth, at my local hospitals the entire time. My homebirth daughter is 31. These issues really aren't that new, or maybe I'm really not THAT old... yes that's it!

Thanks for the answer and a good rationale too! I noticed at a C/S today they had them on the side on a towel like the photo. At my new place we don't circulate felt very odd though when I started L and D we didn't circulate either.

Who does what with babies varies so much from hospital to hospital and unit to unit the answer will vary. What's important is that you have the policy and education to back up the care you give in your facility.

Thanks! The different thing in OB is that the doctor is taking them off the table herself. It's hard for me to imagine them using them curve up....?

I think labor and delivery first makes the most sense actually. Unless your unit is highly specialized you will learn a lot about how to care for postpartum patients in labor and delivery because you will be recovering the mom for the first couple hours postpartum which is when most emergencies happen. A labor nurse can safely float to mother/baby but a mother/baby nurse really can't safely float to labor. Once you are a competent and safe labor nurse you will know what you need to know to handle mospostpartum emergencies. You won't know the nuances of postpartum but it won't take long to be competent there. I would say that they probably are doing it the most effective way to get you up to speed. I agree to that if you don't have the job yet telling them that you prefer postpartum could, to some people, look like you might prefer "easier" work. I wouldn't say it unless asked and then I would stress something like that you like teaching not that you are afraid of labor and delivery. Even though it's appropriate to be anxious about it.. it is intense. But if I were doing the interviewing I would be looking for someone who is enthusiastic about L and D if that is where I have the need for nurses.

This I know is a simple question for an OR nurse. I have been a L and D nurse for 25 years and was taught WAY back when to set up a sterile table with the curved instruments with the curve down ( rationale wouldn't the doc pick them up to use them that way?) I have a new job though and the tech just corrected me and told me I should always have the point up? Is this really a convention? Who is right? I used to circulate but our techs did the set up so I wouldn't absolutely swear that I am right on this one. Nor, in a new job where the tech is merely setting up a table for a delivery am I going to correct her but I might do it my way if my way is actually the OR convention. Thanks.... :)

I have never done anything but OB and am very happy with the choice. But I went to nursing school because I wanted to go into midwifery.... I might not have even become a nurse if I didn't want to be a CNM.. which I never ended up doing but I still love OB nursing. My only suggestion is if you think you might someday want to do something besides OB, even perhaps becoming a nursing instructor, then you might want to get that med/surg experience. You will never be more ready for it than you are now. It would be harder for me now as an experienced RN to go to med/surg than it would have been, I suspect, as a new grad. I have seen it done but rarely and painfully. But if you know L+D/OB is home then I don't think the conventional wisdom that you must earn your med/surg wings first is valid.

I think it's all correlation not causation and that it's terrible that some mother somewhere will refuse and indicated induction and really put her baby in harm's way... ( read what they have to say at Science Based Medicine ).... Also read this about maternity clothes causing pregnancy! Scientists find maternity clothes cause pregnancy | The Skeptical OB

Forgive if double post BUT.... so glad I left Florida long ago and live in California! CNA hospital with great pay, safe ratios mandated by law and happy experienced nurses mentoring wonderful new grads... the way it's supposed to be. You too can make it real... our CEO even says " we need you" unlike the CEO right before we unionized 20 years ago who said if you don't like it find another job and corrected a nurse who had the audacity to speak of delivering excellent care with "the goal is adequate care".... My heart goes out to you Florida nurses you deserve better and so do your patients!